Utilization Management Coordinator Virtual Role AdventHealth Tampa
Location Address:3100 East Fletcher Avenue Tampa, Florida 33613
Top Reasons to Work at AdventHealth Tampa
AdventHealth Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
Surgical Pioneers – the first in Tampa with the latest robotics in spine surgery
Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come
Awarded the Get With The Guidelines – Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.
Full Time Day
YOU ARE REQUIRED TO SUBMIT A RESUME WITH YOUR APPLICATION
You Will Be Responsible For:
Supports clerical and administrative activities of the Utilization Management team
Monitors and addresses electronic faxes and email from payors
Forwards communication to appropriate Utilization Management team member
Enters pertinent approval and denial information into the appropriate computer programs for Utilization Management team members to review and address in a timely manner
Monitors the Centralized Phone Line for telephonic authorization and denial information from payors
Manages and monitors mail from the department mailbox, which includes uploading letters from payors to patient encounters and forwarding correspondences to applicable Departments
Serves as a liaison for payor reviewer, PFS (Patient Financial Services), and Pre-Access
Works closely with the UM Specialist and Supervisor
Tracks and trends payor issues and potential contractual issues and escalates to Utilization Management leadership
Manages multiple clerical duties and assigned projects, while sustaining the department’s key initiatives in support of daily operational flows and special projects as required
Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level before releasing account information.
Completes any other tasks within department guidelines
What You Will Need:
KNOWLEDGE AND SKILLS REQUIRED:
Understanding of Microsoft Office Products and other appropriate software platforms
Ability to communicate effectively and professionally via phone and email
Ability to manage multiple tasks and prioritize level of importance
Ability to perform duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety and a commitment to AH principles
Ability to work with people of all social, economic, and cultural backgrounds; be flexible, open-minded and adaptable to change
Ability to work with minimal supervision
Knowledge of Utilization Management processes preferred
Knowledge of Care Management processes/workflows preferred
EDUCATION AND EXPERIENCE REQUIRED:
High School diploma or GED
Associate degree and/or higher-level education, or completed coursework, in Health Services Administration or other related medical or business field preferred
Experience in health care, hospital setting, and/or Patient Finance Services preferred
The Utilization Management (UM) Coordinator works under the direction of the Utilization Management Manager and supports the Utilization Management team with Emergency, Observation and Inpatient visits. The UM Coordinator is responsible for processing and documenting clinical requests, authorizations/approvals and denial communication from payors via fax (Vyne), email or phone. The UM Coordinator is responsible for collaborating with all members of the UM team or interdependent departments (i.e. Patient Access, Billing, etc.) to ensure unnecessary delays in patient care, discharge or billing.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.